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Sekel NM, Lovalekar M, Koltun KJ, Bird MB, Forse JN, Martin BJ, Nindl BC. Micronutrient Status During Military Training and Associations With Musculoskeletal Health, Injury, and Readiness Outcomes. Int J Sport Nutr Exerc Metab 2024:1-9. [PMID: 39168457 DOI: 10.1123/ijsnem.2024-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Micronutrient status, specifically vitamin D and iron, represent modifiable factors for optimizing military readiness. The primary purpose of this investigation was to determine associations between micronutrient deficiency (i.e., iron status and 25-hydroxy-vitamin D [25(OH)D]) and operationally relevant outcomes (i.e., skeletal health, musculoskeletal injury) at baseline and post-10 weeks of arduous military training. METHODS A total of 227 (177 men, 50 women) Marine Officer Candidates School (OCS) candidates who completed OCS training with complete data sets were included in this analysis. Vitamin D and iron status indicators were collected at two timepoints, pre (baseline) and post OCS. Musculoskeletal outcomes at the mid- and proximal tibial diaphysis were assessed via peripheral quantitative computed tomography. RESULTS Micronutrient status declined following OCS training in men and women and was associated with musculoskeletal outcomes including greater bone strength (strength strain index) at the mid-diaphysis site in those with optimal status (M = 38.26 mm3, SE = 15.59) versus those without (M = -8.03 mm3, SE = 17.27). In women (p = .037), endosteal circumference was greater in the deficient group (M = 53.26 mm, SE = 1.19) compared with the optimal group (M = 49.47 mm, SE = 1.31) at the proximal diaphysis. In men, greater baseline hepcidin concentrations were associated with an increased likelihood of suffering musculoskeletal injury during training. CONCLUSIONS Vitamin D and iron status declined over the course of training, suggesting impaired micronutrient status. Differences in musculoskeletal outcomes by micronutrient group suggests optimal vitamin D and ferritin concentrations may exert beneficial effects on bone fatigability and fracture reduction during military training.
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Affiliation(s)
- Nicole M Sekel
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristen J Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew B Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer N Forse
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian J Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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2
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Badenhorst CE, Forsyth AK, Govus AD. A contemporary understanding of iron metabolism in active premenopausal females. Front Sports Act Living 2022; 4:903937. [PMID: 35966107 PMCID: PMC9366739 DOI: 10.3389/fspor.2022.903937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Iron metabolism research in the past decade has identified menstrual blood loss as a key contributor to the prevalence of iron deficiency in premenopausal females. The reproductive hormones estrogen and progesterone influence iron regulation and contribute to variations in iron parameters throughout the menstrual cycle. Despite the high prevalence of iron deficiency in premenopausal females, scant research has investigated female-specific causes and treatments for iron deficiency. In this review, we provide a comprehensive discussion of factors that influence iron status in active premenopausal females, with a focus on the menstrual cycle. We also outline several practical guidelines for monitoring, diagnosing, and treating iron deficiency in premenopausal females. Finally, we highlight several areas for further research to enhance the understanding of iron metabolism in this at-risk population.
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Affiliation(s)
- Claire E. Badenhorst
- School of Sport, Exercise, and Nutrition, College of Health, Massey University, Auckland, New Zealand
- *Correspondence: Claire E. Badenhorst
| | - Adrienne K. Forsyth
- School of Behavioural and Health Science, Australian Catholic University, Fitzroy, VIC, Australia
| | - Andrew D. Govus
- Discipline of Sport and Exercise, Department of Sport, Exercise, and Nutrition Science, La Trobe University, Melbourne, VIC, Australia
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Ishibashi A, Maeda N, Kojima C, Goto K. Iron Metabolism following Twice a Day Endurance Exercise in Female Long-Distance Runners. Nutrients 2022; 14:nu14091907. [PMID: 35565873 PMCID: PMC9105615 DOI: 10.3390/nu14091907] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Iron deficiency anemia (IDA) and iron deficiency (ID) are frequently observed among endurance athletes. The iron regulatory hormone hepcidin may be involved in IDA and/or ID. Endurance athletes incorporate multiple training sessions, but the influence of repeated bouts of endurance exercise within the same day on iron metabolism remains unclear. Therefore, the purpose of the present study was to investigate the influence of twice a day endurance exercise on iron metabolism, including the hepcidin level, in female long-distance runners. Thirteen female long-distance runners participated in this study. They completed the twice-a-day endurance exercise in the morning and afternoon. Blood samples were collected four times in total: at 06:00 (P0), 14:00 (P8), 20:00 (P14), and 06:00 the next day (P24). In addition to the blood variables, nutritional intake was assessed throughout the exercise day. Serum hepcidin levels were significantly elevated (compared to P0) until the following morning (P24). Moreover, dietary analysis revealed that subjects consumed a low volume of carbohydrates (<6 g/kg body mass/day). In conclusion, twice a day endurance exercise resulted in significant elevation of serum hepcidin level 24 h after completion of the exercise in female long-distance runners. Therefore, athletes with a high risk of anemia should pay attention to training frequency and nutritional intake in order to maintain optimal iron metabolism.
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Affiliation(s)
- Aya Ishibashi
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo 153-8902, Japan;
| | - Naho Maeda
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan;
| | - Chihiro Kojima
- Department of Sports Science, Japan Institute of Sports Science, Tokyo 115-0056, Japan;
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan;
- Correspondence: ; Tel./Fax: +81-77-599-4127
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4
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Bonilla DA, Moreno Y, Petro JL, Forero DA, Vargas-Molina S, Odriozola-Martínez A, Orozco CA, Stout JR, Rawson ES, Kreider RB. A Bioinformatics-Assisted Review on Iron Metabolism and Immune System to Identify Potential Biomarkers of Exercise Stress-Induced Immunosuppression. Biomedicines 2022; 10:724. [PMID: 35327526 PMCID: PMC8945881 DOI: 10.3390/biomedicines10030724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
The immune function is closely related to iron (Fe) homeostasis and allostasis. The aim of this bioinformatics-assisted review was twofold; (i) to update the current knowledge of Fe metabolism and its relationship to the immune system, and (ii) to perform a prediction analysis of regulatory network hubs that might serve as potential biomarkers during stress-induced immunosuppression. Several literature and bioinformatics databases/repositories were utilized to review Fe metabolism and complement the molecular description of prioritized proteins. The Search Tool for the Retrieval of Interacting Genes (STRING) was used to build a protein-protein interactions network for subsequent network topology analysis. Importantly, Fe is a sensitive double-edged sword where two extremes of its nutritional status may have harmful effects on innate and adaptive immunity. We identified clearly connected important hubs that belong to two clusters: (i) presentation of peptide antigens to the immune system with the involvement of redox reactions of Fe, heme, and Fe trafficking/transport; and (ii) ubiquitination, endocytosis, and degradation processes of proteins related to Fe metabolism in immune cells (e.g., macrophages). The identified potential biomarkers were in agreement with the current experimental evidence, are included in several immunological/biomarkers databases, and/or are emerging genetic markers for different stressful conditions. Although further validation is warranted, this hybrid method (human-machine collaboration) to extract meaningful biological applications using available data in literature and bioinformatics tools should be highlighted.
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Affiliation(s)
- Diego A. Bonilla
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogota 110311, Colombia; (Y.M.); (J.L.P.)
- Research Group in Biochemistry and Molecular Biology, Faculty of Science and Education, Universidad Distrital Francisco José de Caldas, Bogota 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
| | - Yurany Moreno
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogota 110311, Colombia; (Y.M.); (J.L.P.)
- Research Group in Biochemistry and Molecular Biology, Faculty of Science and Education, Universidad Distrital Francisco José de Caldas, Bogota 110311, Colombia
| | - Jorge L. Petro
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogota 110311, Colombia; (Y.M.); (J.L.P.)
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
| | - Diego A. Forero
- Health and Sport Sciences Research Group, School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá 111221, Colombia; (D.A.F.); (C.A.O.)
| | - Salvador Vargas-Molina
- Faculty of Sport Sciences, EADE-University of Wales Trinity Saint David, 29018 Málaga, Spain;
| | - Adrián Odriozola-Martínez
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
- kDNA Genomics, Joxe Mari Korta Research Center, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Carlos A. Orozco
- Health and Sport Sciences Research Group, School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá 111221, Colombia; (D.A.F.); (C.A.O.)
| | - Jeffrey R. Stout
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL 32816, USA;
| | - Eric S. Rawson
- Department of Health, Nutrition and Exercise Science, Messiah University, Mechanicsburg, PA 17055, USA;
| | - Richard B. Kreider
- Exercise & Sport Nutrition Laboratory, Human Clinical Research Facility, Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA;
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5
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Kuwabara AM, Tenforde AS, Finoff JT, Fredericson M. Iron Deficiency in Athletes: A Narrative Review. PM R 2022; 14:620-642. [DOI: 10.1002/pmrj.12779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Anne M. Kuwabara
- Stanford University, Department of Physical Medicine and Rehabilitation, 450 Broadway Street, Pavilion C, 4th Floor Redwood City California United States
| | - Adam S. Tenforde
- Harvard Medical School, Department of Physical Medicine and Rehabilitation Assistant Professor of Physical Medicine and Rehabilitation
| | | | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation Stanford University Medical Center
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6
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Hennigar SR, McClung JP, Hatch-McChesney A, Allen JT, Wilson MA, Carrigan CT, Murphy NE, Teien HK, Martini S, Gwin JA, Karl JP, Margolis LM, Pasiakos SM. Energy deficit increases hepcidin and exacerbates declines in dietary iron absorption following strenuous physical activity: a randomized-controlled cross-over trial. Am J Clin Nutr 2021; 113:359-369. [PMID: 33184627 DOI: 10.1093/ajcn/nqaa289] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Strenuous physical activity promotes inflammation and depletes muscle glycogen, which may increase the iron regulatory hormone hepcidin. Hepcidin reduces dietary iron absorption and may contribute to declines in iron status frequently observed following strenuous physical activity. OBJECTIVES To determine the effects of strenuous physical activity on hepcidin and dietary iron absorption and whether energy deficit compared with energy balance modifies those effects. METHODS This was a randomized, cross-over, controlled-feeding trial in healthy male subjects (n = 10, mean ± SD age: 22.4 ± 5.4 y, weight: 87.3 ± 10.9 kg) with sufficient iron status (serum ferritin 77.0 ± 36.7 ng/mL). Rest measurements were collected before participants began a 72-h simulated sustained military operation (SUSOPS), designed to elicit high energy expenditure, glycogen depletion, and inflammation, followed by a 7-d recovery period. Two 72-h SUSOPS trials were performed where participants were randomly assigned to consume either energy matched (±10%) to their individual estimated total daily energy expenditure (BAL) or energy at 45% of total daily energy expenditure to induce energy deficit (DEF). On the rest day and at the completion of BAL and DEF, participants consumed a beverage containing 3.8 mg of a stable iron isotope, and plasma isotope appearance was measured over 6 h. RESULTS Muscle glycogen declined during DEF and was preserved during BAL (-188 ± 179 mmol/kg, P-adjusted < 0.01). Despite similar increases in interleukin-6, plasma hepcidin increased during DEF but not BAL, such that hepcidin was 108% greater during DEF compared with BAL (7.8 ± 12.2 ng/mL, P-adjusted < 0.0001). Peak plasma isotope appearance at 120 min was 74% lower with DEF (59 ± 38% change from 0 min) and 49% lower with BAL (117 ± 81%) compared with rest (230 ± 97%, P-adjusted < 0.01 for all comparisons). CONCLUSIONS Strenuous physical activity decreases dietary iron absorption compared with rest. Energy deficit exacerbates both the hepcidin response to physical activity and declines in dietary iron absorption compared with energy balance. This trial was registered at clinicaltrials.gov as NCT03524690.
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Affiliation(s)
- Stephen R Hennigar
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL, USA.,Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Adrienne Hatch-McChesney
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Jillian T Allen
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - Marques A Wilson
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Christopher T Carrigan
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Hilde K Teien
- Norwegian Defense Research Establishment, Kjeller, Norway
| | - Svein Martini
- Norwegian Defense Research Establishment, Kjeller, Norway
| | - Jess A Gwin
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute of Science and Technology, Belcamp, MD, USA
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
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7
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Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions. Nutrients 2021; 13:nu13020482. [PMID: 33535496 PMCID: PMC7912724 DOI: 10.3390/nu13020482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.
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8
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Larsuphrom P, Latunde-Dada GO. Association of Serum Hepcidin Levels with Aerobic and Resistance Exercise: A Systematic Review. Nutrients 2021; 13:393. [PMID: 33513924 PMCID: PMC7911648 DOI: 10.3390/nu13020393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prevalence of iron deficiency is commonly reported among athletic population groups. It impairs physical performance due to insufficient oxygen delivery to target organs and low energy production. This is due to the high demand of exercise on oxygen delivery for systemic metabolism by the erythrocytes in the blood. Hepcidin, the key regulator of iron homeostasis, decreases to facilitate iron efflux into the circulation during enhanced erythropoiesis. However, acute anaemia of exercise is caused by increased hepcidin expression that is induced by stress and inflammatory signal. The study aimed to systematically review changes in serum hepcidin levels during resistance and aerobic exercise programmes. METHODS A systemic literature search from 2010 to April 2020 across seven databases comprised of Cochrane library, PubMed, Web of Science, Scopus, Embase, MEDLINE, and OpenGrey. The primary outcome was increased or decreased serum hepcidin from baseline after the exercise activity. Risks of bias were evaluated by using the National Institutes of Health (NIH) for quality assessment of before and after different exercise programmes. RESULTS Overall, twenty-three studies met the inclusion criteria. Out of the 23 studies, 16 studies reported significantly exercise-induced serum hepcidin elevation. Of the 17 studies that evaluated serum interleukin (IL)-6 levels, 14 studies showed significant exercise-induced serum IL-6 elevation. Changes in exercise-induced serum hepcidin and IL-6 levels were similar in both resistance and endurance exercise. Significant correlations were observed between post-exercise hepcidin and baseline ferritin levels (r = 0.69, p < 0.05) and between post-exercise hepcidin and post-exercise IL-6 (r = 0.625, p < 0.05). CONCLUSION Resistance and endurance training showed significant increase in serum hepcidin and IL-6 levels in response to exercise. Baseline ferritin and post-exercise IL-6 elevation are key determining factors in the augmentation of hepcidin response to exercise.
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Affiliation(s)
| | - Gladys Oluyemisi Latunde-Dada
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, Franklin-Wilkins-Building, 150 Stamford Street, London SE1 9NH, UK;
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9
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Elia A, Barlow MJ, Wilson OJ, O'Hara JP. Six weeks of dynamic apnoeic training stimulates erythropoiesis but does not increase splenic volume. Eur J Appl Physiol 2020; 121:827-838. [PMID: 33372236 PMCID: PMC7892731 DOI: 10.1007/s00421-020-04565-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
Purpose This study examined the influence of dynamic apnoea training on splenic volume and haematological responses in non-breath-hold divers (BHD). Methods Eight non-BHD performed ten maximal dynamic apnoeas, four times a week for six weeks. Splenic volumes were assessed ultrasonically, and blood samples were drawn for full blood count analysis, erythropoietin, iron, ferritin, albumin, protein and osmolality at baseline, 24 h post the completion of each week’s training sessions and seven days post the completion of the training programme. Additionally, blood samples were drawn for haematology at 30, 90, and 180 min post session one, twelve and twenty-four. Results Erythropoietin was only higher than baseline (6.62 ± 3.03 mlU/mL) post session one, at 90 (9.20 ± 1.88 mlU/mL, p = 0.048) and 180 min (9.04 ± 2.35 mlU/mL, p = 0.046). Iron increased from baseline (18 ± 3 µmol/L) post week five (23 ± 2 µmol/L, p = 0.033) and six (21 ± 6 µmol/L; p = 0.041), whereas ferritin was observed to be lower than baseline (111 ± 82 µg/L) post week five (95 ± 75 µg/L; p = 0.016), six (84 ± 74 µg/L; p = 0.012) and one week post-training (81 ± 63 µg/L; p = 0.008). Reticulocytes increased from baseline (57 ± 12 × 109/L) post week one (72 ± 17 × 109/L, p = 0.037) and six (71 ± 17 × 109/L, p = 0.021) while no changes were recorded in erythrocytes (p = 0.336), haemoglobin (p = 0.124) and splenic volumes (p = 0.357). Conclusions Six weeks of dynamic apnoeic training increase reticulocytes without altering mature erythrocyte concentration and splenic volume.
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Affiliation(s)
- Antonis Elia
- Division of Environmental Physiology, School of Chemistry, Bioengineering and Health, KTH Royal Institute of Technology, Berzelius väg 13, Solna, 171 65, Stockholm, Sweden. .,Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
| | | | - Oliver J Wilson
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - John P O'Hara
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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10
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Alfaro-Magallanes VM, Benito PJ, Rael B, Barba-Moreno L, Romero-Parra N, Cupeiro R, Swinkels DW, Laarakkers CM, Peinado AB. Menopause Delays the Typical Recovery of Pre-Exercise Hepcidin Levels after High-Intensity Interval Running Exercise in Endurance-Trained Women. Nutrients 2020; 12:nu12123866. [PMID: 33348847 PMCID: PMC7766833 DOI: 10.3390/nu12123866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Menopause commonly presents the gradual accumulation of iron in the body over the years, which is a risk factor for diseases such as cancer, osteoporosis, or cardiovascular diseases. Running exercise is known to acutely increase hepcidin levels, which reduces iron absorption and recycling. As this fact has not been studied in postmenopausal women, this study investigated the hepcidin response to running exercise in this population. Thirteen endurance-trained postmenopausal women (age: 51.5 ± 3.89 years; height: 161.8 ± 4.9 cm; body mass: 55.9 ± 3.6 kg; body fat: 24.7 ± 4.2%; peak oxygen consumption: 42.4 ± 4.0 mL·min-1·kg-1) performed a high-intensity interval running protocol, which consisted of 8 × 3 min bouts at 85% of the maximal aerobic speed with 90-second recovery. Blood samples were collected pre-exercise, 0, 3, and 24 hours post-exercise. As expected, hepcidin exhibited higher values at 3 hours post-exercise (3.69 ± 3.38 nmol/L), but also at 24 hours post-exercise (3.25 ± 3.61 nmol/L), in comparison with pre-exercise (1.77 ± 1.74 nmol/L; p = 0.023 and p = 0.020, respectively) and 0 hour post-exercise (2.05 ± 2.00 nmol/L; p = 0.021 and p = 0.032, respectively) concentrations. These differences were preceded by a significant increment of interleukin-6 at 0 hour post-exercise (3.41 ± 1.60 pg/mL) compared to pre-exercise (1.65 ± 0.48 pg/m, p = 0.003), 3 hours (1.50 ± 0.00 pg/mL, p = 0.002) and 24 hours post-exercise (1.52 ± 0.07 pg/mL, p = 0.001). Hepcidin peaked at 3 hours post-exercise as the literature described for premenopausal women but does not seem to be fully recovered to pre-exercise levels within 24 hours post-exercise, as it would be expected. This suggests a slower recovery of basal hepcidin levels in postmenopausal women, suggesting interesting applications in order to modify iron homeostasis as appropriate, such as the prevention of iron accumulation or proper timing of iron supplementation.
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Affiliation(s)
- Víctor M. Alfaro-Magallanes
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Pedro J. Benito
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
- Correspondence: ; Tel.: +34-910-677-866
| | - Beatriz Rael
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Laura Barba-Moreno
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Nuria Romero-Parra
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Rocío Cupeiro
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
| | - Dorine W. Swinkels
- Translational Metabolic Laboratory (TML 830), Medical Center, Department of Laboratory Medicine, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (D.W.S.); (C.M.L.)
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA Nijmegen, The Netherlands
| | - Coby M. Laarakkers
- Translational Metabolic Laboratory (TML 830), Medical Center, Department of Laboratory Medicine, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (D.W.S.); (C.M.L.)
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA Nijmegen, The Netherlands
| | - Ana B. Peinado
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain; (V.M.A.-M.); (B.R.); (L.B.-M.); (N.R.-P.); (R.C.); (A.B.P.)
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11
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Barba-Moreno L, Alfaro-Magallanes VM, de Jonge XAKJ, Díaz AE, Cupeiro R, Peinado AB. Hepcidin and interleukin-6 responses to endurance exercise over the menstrual cycle. Eur J Sport Sci 2020; 22:218-226. [PMID: 33317411 DOI: 10.1080/17461391.2020.1853816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of the current study was to investigate iron metabolism in endurance trained women through the interleukin-6, hepcidin and iron responses to exercise along different endogenous hormonal states. Fifteen women performed 40 min treadmill running trials at 75% vVO2peak during three specific phases of the menstrual cycle: early follicular phase (day 3 ± 0.85), mid-follicular phase (day 8 ± 1.09) and luteal phase (day 21 ± 1.87). Venous blood samples were taken pre-, 0 h post- and 3 h post-exercise. Interleukin-6 reported a significant interaction for menstrual cycle phase and time (p=0.014), showing higher interleukin-6 levels at 3 h post-exercise during luteal phase compared to the early follicular phase (p=0.004) and the mid-follicular phase (p=0.002). Iron levels were significantly lower (p=0.009) during the early follicular phase compared to the mid-follicular phase. However, hepcidin levels were not different across menstrual cycle phases (p>0.05). The time-course for hepcidin and interleukin-6 responses to exercise was different from the literature, since hepcidin peak levels occurred at 0 h post-exercise, whereas the highest interleukin-6 levels occurred at 3 h post-exercise. We concluded that menstrual cycle phases may alter interleukin-6 production causing a higher inflammation when progesterone levels are elevated (days 19-21). Moreover, during the early follicular phase a significant reduction of iron levels is observed potentially due to a loss of haemoglobin through menses. According to our results, high intensity exercises should be carefully monitored in these phases in order not to further compromise iron stores.
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Affiliation(s)
- Laura Barba-Moreno
- Faculty of Sciences for Physical Activity and Sport (INEF), LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Víctor M Alfaro-Magallanes
- Faculty of Sciences for Physical Activity and Sport (INEF), LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Angel E Díaz
- AEPSAD, Clinical laboratory, National Center of Sport Medicine, Health and Sports Department, Madrid, Spain
| | - Rocío Cupeiro
- Faculty of Sciences for Physical Activity and Sport (INEF), LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Ana B Peinado
- Faculty of Sciences for Physical Activity and Sport (INEF), LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
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12
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Kasprowicz K, Ratkowski W, Wołyniec W, Kaczmarczyk M, Witek K, Żmijewski P, Renke M, Jastrzębski Z, Rosemann T, Nikolaidis PT, Knechtle B. The Effect of Vitamin D 3 Supplementation on Hepcidin, Iron, and IL-6 Responses after a 100 km Ultra-Marathon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082962. [PMID: 32344650 PMCID: PMC7215841 DOI: 10.3390/ijerph17082962] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
Deficiencies in iron and vitamin D are frequently observed in athletes. Therefore, we examined whether different baseline vitamin D3 levels have any impact on post-exercise serum hepcidin, IL-6 and iron responses in ultra-marathon runners. In this randomized control trial, the subjects (20 male, amateur runners, mean age 40.75 ± 7.15 years) were divided into two groups: experimental (VD) and control (CON). The VD group received vitamin D3 (10,000 UI/day) and the CON group received a placebo for two weeks before the run. Venous blood samples were collected on three occasions-before the run, after the 100 km ultra-marathon and 12 h after the run-to measure iron metabolism indicators, hepcidin, and IL-6 concentration. After two weeks of supplementation, the intervention group demonstrated a higher level of serum 25(OH)D than the CON group (27.82 ± 5.8 ng/mL vs. 20.41 ± 4.67 ng/mL; p < 0.05). There were no differences between the groups before and after the run in the circulating hepcidin and IL-6 levels. The decrease in iron concentration immediately after the 100-km ultra-marathon was smaller in the VD group than CON (p < 0.05). These data show that various vitamin D3 status can affect the post-exercise metabolism of serum iron.
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Affiliation(s)
- Katarzyna Kasprowicz
- Department of Molecular Biology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
- Correspondence: (K.K.); (B.K.)
| | - Wojciech Ratkowski
- Department of Athletics, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdansk, 81-519 Gdynia, Poland; (W.W.); (M.R.)
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-11 Szczecin, Poland;
| | - Konrad Witek
- Department of Biochemistry, Institute of Sport, National Research Institute, 01-982 Warsaw, Poland;
| | - Piotr Żmijewski
- Faculty of Physical Education, Jozef Piłsudski University of Physical Education in Warsaw, 01-813 Warsaw, Poland;
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdansk, 81-519 Gdynia, Poland; (W.W.); (M.R.)
| | - Zbigniew Jastrzębski
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
- Correspondence: (K.K.); (B.K.)
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13
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Marathon Run-induced Changes in the Erythropoietin-Erythroferrone-Hepcidin Axis are Iron Dependent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082781. [PMID: 32316587 PMCID: PMC7216253 DOI: 10.3390/ijerph17082781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
Alterations in iron metabolism after physical activity are manifested through the rise of blood hepcidin (Hpc) levels. However, in many athletes, no changes in Hpc levels are observed after exercise despite the presence of inflammation. The missing links could be erythropoietin (EPO) and erythroferrone (ERFE), which down-regulate Hpc biosynthesis. EPO, ERFE and Hpc biosynthesis is modified by serum iron through transferrin receptor 2. Consequently, we investigated whether marathon-induced changes in EPO, ERFE and Hpc levels are blood iron-dependent. Twenty-nine healthy male marathon runners were analyzed. Serum iron, ferritin, transferrin, EPO, ERFE and Hpc levels were assessed before, immediately after, and 9 ± 2 days after the marathon. The runners whose serum Hpc decreased after the marathon (n = 15), showed a significant increase in ERFE levels. In athletes whose serum iron levels were below 105 µg/day (n = 15), serum EPO (p = 0.00) and ERFE levels (p = 0.00) increased with no changes in Hpc concentration. However, in athletes with low serum iron, no changes in EPO levels were observed when serum ferritin exceeded 70 ng/mL (n = 7). Conversely, an increase in ERFE levels was observed in marathoners with low serum iron, independently of serum ferritin (n = 7). This indicates modulation of blood iron may affect exercise-induced changes in the EPO/ERFE/Hpc axis. Further study is needed to fully understand the physiological meaning of the interdependence between iron and the EPO/ERFE/Hpc axis.
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Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
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Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Nabhan D, Bielko S, Sinex JA, Surhoff K, Moreau WJ, Schumacher YO, Bahr R, Chapman RF. Serum ferritin distribution in elite athletes. J Sci Med Sport 2019; 23:554-558. [PMID: 31901316 DOI: 10.1016/j.jsams.2019.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/21/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES It is not uncommon for athletes to be diagnosed with iron deficiency, yet there remains uncertainty whether the prevalence of suboptimal iron status in elite athletes differs from the normal population or warrants routine screening. The purpose of this study is to describe the distribution of serum ferritin (SF) in a cohort of elite athletes. DESIGN Retrospective cohort study. METHODS Electronic health records of 1085 elite adult athletes (570 women, 515 men) from 2012-2017 were examined retrospectively. SF values were compared to published normal population data. The proportion of athletes meeting criterion values for iron deficiency or initiation of treatment was examined. RESULTS SF distributions in male athletes were significantly lower than normal males aged 20 to <24yrs. (χ2 28.8, p<0.001) and aged 24 to <28yrs. (χ2 91.9, p<0.001). SF status was similar in female athletes and normal women aged 20 to <24yrs. (χ2 9.5, p>0.05) or aged 24 to <28yrs. (χ2 11.5, p>0.05). Using 35ng/ml as the criterion value for stage one iron deficiency, 15% of male athletes and 52% of female athletes displayed suboptimal iron status. CONCLUSIONS Male athletes have a significantly lower population distribution of SF values as compared to normative data on healthy males, with 15% of male athletes having suboptimal SF status. The distribution of SF values in elite female athletes did not differ from population values, however approximately half women athletes were iron deficient. These data suggest that iron screening should be considered in both male and female athlete populations.
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Affiliation(s)
- Dustin Nabhan
- Sports Medicine Division, United States Olympic and Paralympic Commitee, USA.
| | - Shane Bielko
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
| | - Jacob A Sinex
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
| | - Kendall Surhoff
- Department of Allied Health Services, University of North Carolina Chapel Hill, USA
| | | | | | - Roald Bahr
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Norway
| | - Robert F Chapman
- Human Performance Laboratory, Department of Kinesiology, Indiana University, USA
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The Short Tandem Repeat of the DMT1 Gene as a Molecular Marker of Elite Long-Distance Runners. Int J Genomics 2019; 2019:7064703. [PMID: 31871928 PMCID: PMC6906879 DOI: 10.1155/2019/7064703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/01/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
The DMT1 gene encodes divalent metal transporter 1, a membrane iron transport protein. Divalent metal transporter 1 influences cellular iron availability, which might further affect aerobic exercise capacity. Short tandem repeat (STR) polymorphisms have been used as genetic markers in the literature, yet the STR polymorphisms of the DMT1 gene have not been well studied. In this current study, we explored the polymorphisms of the DMT1 gene in a group of elite long-distance runners and controls, by using the PCR-RFLP (Restriction Fragment Length Polymorphism) and Gene scan technology. We found that the genotype frequency of the homozygous 258 bp STR polymorphism of the DMT1 gene (258 bp/258 bp) was significantly higher in the athlete group than in the controls (χ2 = 14.01, p = 0.006) so does the allele frequency of the 258 bp STR polymorphism (χ2 = 12.867, p = 0.008). These data suggested that the STR polymorphism of the DMT1 gene might be correlated with aerobic exercise capacity and the 258 bp homozygous (25 bp/258 bp) could be used as a molecular marker for the talent identification of elite long-distance runners.
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Grzybkowska A, Anczykowska K, Ratkowski W, Aschenbrenner P, Antosiewicz J, Bonisławska I, Żychowska M. Changes in Serum Iron and Leukocyte mRNA Levels of Genes Involved in Iron Metabolism in Amateur Marathon Runners-Effect of the Running Pace. Genes (Basel) 2019; 10:E460. [PMID: 31208055 PMCID: PMC6627308 DOI: 10.3390/genes10060460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Iron is essential for physical activity due to its role in energy production pathways and oxygen transportation via hemoglobin and myoglobin. Changes in iron-related biochemical parameters after physical exercise in athletes are of substantial research interest, but molecular mechanisms such as gene expression are still rarely tested in sports. In this paper, we evaluated the mRNA levels of genes related to iron metabolism (PCBP1, PCBP2, FTL, FTH, and TFRC) in leukocytes of 24 amateur runners at four time points: before, immediately after, 3 h after, and 24 h after a marathon. We measured blood morphology as well as serum concentrations of iron, ferritin, and C-reactive protein (CRP). Our results showed significant changes in gene expression (except for TFRC), serum iron, CRP, and morphology after the marathon. However, the alterations in mRNA and protein levels occurred at different time points (immediately and 3 h post-run, respectively). The levels of circulating ferritin remained stable, whereas the number of transcripts in leukocytes differed significantly. We also showed that running pace might influence mRNA expression. Our results indicated that changes in the mRNA of genes involved in iron metabolism occurred independently of serum iron and ferritin concentrations.
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Affiliation(s)
- Agata Grzybkowska
- Department of Biochemistry, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Katarzyna Anczykowska
- Department of Biochemistry, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Wojciech Ratkowski
- Department of Management in Tourism and Recreation, Faculty of Tourism and Recreation, University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Piotr Aschenbrenner
- Department of Life Sciences, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Jędrzej Antosiewicz
- Department of Biochemistry, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Iwona Bonisławska
- Department of Anatomy and Anthropology, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
| | - Małgorzata Żychowska
- Department of Life Sciences, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
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18
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Iron considerations for the athlete: a narrative review. Eur J Appl Physiol 2019; 119:1463-1478. [PMID: 31055680 DOI: 10.1007/s00421-019-04157-y] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023]
Abstract
Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15-35% athlete cohorts deficient), approximately 5-11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete's iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.
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19
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Iron status and associations with physical performance during basic combat training in female New Zealand Army recruits. Br J Nutr 2019; 121:887-893. [PMID: 30862317 DOI: 10.1017/s0007114519000199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Decreases in Fe status have been reported in military women during initial training periods of 8-10 weeks. The present study aimed to characterise Fe status and associations with physical performance in female New Zealand Army recruits during a 16-week basic combat training (BCT) course. Fe status indicators - Hb, serum ferritin (sFer), soluble transferrin receptor (sTfR), transferrin saturation (TS) and erythrocyte distribution width (RDW) - were assessed at the beginning (baseline) and end of BCT in seventy-six volunteers without Fe-deficiency non-anaemia (sFer 10 mg/l at baseline or end. A timed 2·4 km run followed by maximum press-ups were performed at baseline and midpoint (week 8) to assess physical performance. Changes in Fe status were investigated using paired t tests and associations between Fe status and physical performance evaluated using Pearson correlation coefficients. sFer (56·6 (sd 33·7) v. 38·4 (sd 23·8) µg/l) and TS (38·8 (sd 13·9) v. 34·4 (sd 11·5) %) decreased (P<0·001 and P=0·014, respectively), while sTfR (1·21 (sd 0·27) v. 1·39 (sd 0·35) mg/l) and RDW (12·8 (sd 0·6) v. 13·2 (sd 0·7) %) increased (P<0·001) from baseline to end. Hb (140·6 (sd 7·5) v. 142·9 (sd 7·9) g/l) increased (P=0·009) during BCT. At end, sTfR was positively (r 0·29, P=0·012) and TS inversely associated (r -0·32, P=0·005) with midpoint run time. There were no significant correlations between Fe status and press-ups. Storage and functional Fe parameters indicated a decline in Fe status in female recruits during BCT. Correlations between tissue-Fe indicators and run times suggest impaired aerobic fitness. Optimal Fe status appears paramount for enabling success in female recruits during military training.
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Abstract
Iron and zinc are nutritionally essential trace elements that function through incorporation into proteins and enzymes; many of these proteins and enzymes affect physical performance. Poor iron status (iron deficiency and iron deficiency anemia) is prevalent in both developed and developing nations. Zinc deficiency has been reported in clinical and population studies, although the incidence is difficult to quantify due to the lack of a reliable zinc status indicator. The objective of this manuscript is to review the relationship between iron and zinc status and physical performance. In sum, numerous reports indicate diminished physical performance in individuals with poor iron and/or zinc status, whereas, in individuals with adequate status, evidence supporting a beneficial role of iron or zinc at levels beyond the recommended dietary allowance for optimizing physical performance is lacking.
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Affiliation(s)
- James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA.
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21
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Hayashi N, Ishibashi A, Goto K. Effects of diet before endurance exercise on hepcidin response in young untrained females. Phys Act Nutr 2018; 22:55-61. [PMID: 30661331 PMCID: PMC6343765 DOI: 10.20463/jenb.2018.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022] Open
Abstract
[Purpose] We examined the effects of diet before endurance exercise on hepcidin response in young untrained females. [Methods] Ten young untrained females [age: 20.6 ± 0.8 y, height: 157.5 ± 1.0 cm, weight: 54.4 ± 1.5 kg, and maximal oxygen uptake (VO2max): 35.9 ± 1.1 mL/kg/min] were involved in two experimental conditions with a crossover design. The two conditions were separated by approximately 1 month, and each condition was performed during the follicular phase. Subjects completed 60 min of pedaling at 65% of VO2max after consuming a meal (FED) or not consuming a meal (CON). Blood samples were collected before, immediately after, and 3 h after exercise. [Results] Serum ferritin levels before exercise did not differ between the two conditions (P > 0.05). Blood glucose and lactate levels were significantly elevated immediately after exercise only under the FED condition (P < 0.05). Serum iron levels were significantly elevated after exercise under both conditions. However, the plasma interleukin-6 and serum hepcidin levels were not significantly different 3 h after exercise under either condition (P > 0.05). [Conclusion] Consuming a meal before endurance exercise at moderate intensity did not affect exercise-induced hepcidin elevation in young untrained females.
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Repressed Exercise-Induced Hepcidin Levels after Danggui Buxue Tang Supplementation in Male Recreational Runners. Nutrients 2018; 10:nu10091318. [PMID: 30231484 PMCID: PMC6165347 DOI: 10.3390/nu10091318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 12/13/2022] Open
Abstract
This study was to investigate the protective and recovery effects of Danggui Buxue Tang (DBT) supplementation on exercise performance, hepcidin, iron status, and other related biochemical parameters after being challenged by a single bout of intense aerobic exercise. A total of 36 recreationally active males were pair-matched and randomly assigned to receive DBT or a placebo for 11 days, while using clusters based on their aerobic capacities. On the eighth day of the supplementation, the participants performed a 13-km run with maximal effort. Blood and urine samples were collected and analysed before treatment (Pre-Tre) and immediately after (Post-Ex), 24 h after (24-h Rec), and 72 h after (72-h Rec) the run. DBT supplementation dramatically shortened the finish times by 14.0% (12.3 min) when compared with that in the placebo group. Significant group × time effects were observed in serum hepcidin and iron levels. DBT supplementation repressed hepcidin levels at Post-Ex and 24-h Rec, thereby causing a significant increase in iron levels by 63.3% and 31.4% at Post-Ex and 72-h Rec, respectively. However, DBT supplementation had no significant anti-inflammatory or haemolysis-preventative effects. Short-term DBT supplementation shortened the running time and repressed exercise-induced hepcidin levels, thereby boosting iron levels and accelerating iron homeostasis during recovery.
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Bauer P, Zeissler S, Walscheid R, Frech T, Hillebrecht A. Acute effects of high-intensity exercise on hematological and iron metabolic parameters in elite male and female dragon boating athletes. PHYSICIAN SPORTSMED 2018; 46:335-341. [PMID: 29847191 DOI: 10.1080/00913847.2018.1482187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the acute effects of high-intensity exercise on blood hepcidin levels and other iron metabolic and hematological parameters in highly trained athletes of dragon boating as a sport performed in a sitting position. METHODS We conducted an exercise intervention study with a pre- and posttest blood measurement to determine the effects of high-intensity training on hematological and iron metabolic parameters in both male (n = 19) and female (n = 12) elite athletes of the German national dragon boating team. The study took place during the final training camp before the European championships. Blood samples were collected at baseline and 3 h after 3 consecutive high-intensity training bouts at the same day, each one lasting 1 h in duration. RESULTS After exercise, leukocytes, CPK, CKMB, and hepcidin levels increased significantly both in men and women. In contrast, iron concentrations decreased significantly. No gender-related differences were found. Compared with baseline, the postexercise concentrations of serum iron decreased significantly both in men [99.3 ± 46.3 to 61.2 ± 20.9 µg/dL (p < 0.001)] and in women [116.3 ± 34 to 67.1 ± 21.8 µg/dL (p < 0.001)] without a gender difference (p = 0.28). Hepcidin levels increased significantly both in men [9.1 ± 6.5 to 12.2 ± 5.8 ng/mL (p < 0.001)] and in women [8.0 ± 4.6 to 11.7 ± 5.7 ng/mL (p < 0.001)] without a significant gender difference in hepcidin changes (p = 0.34). CONCLUSIONS In conclusion, three consecutive high-intensity training bouts lead to elevated hepcidin levels and decreased iron levels in elite athletes of dragon boating. The increase in hepcidin levels may contribute to the risk of anemia in these athletes.
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Affiliation(s)
- Pascal Bauer
- a Cardiology and Angiology , University Hospital Giessen , Giessen , Germany
| | | | - Rüdiger Walscheid
- c MVZ for Laboratory Medicine and Microbiology Koblenz- Mittelrhein , Koblenz , Germany
| | - Torsten Frech
- d Sports Medicine, Justus- Liebig University Giessen , Giessen , Germany
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Terink R, Ten Haaf D, Bongers CWG, Balvers MGJ, Witkamp RF, Mensink M, Eijsvogels TMH, Gunnewiek JMTK, Hopman MTE. Changes in iron metabolism during prolonged repeated walking exercise in middle-aged men and women. Eur J Appl Physiol 2018; 118:2349-2357. [PMID: 30167958 PMCID: PMC6182319 DOI: 10.1007/s00421-018-3961-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/01/2018] [Indexed: 01/01/2023]
Abstract
Purpose The aim of the present study was to assess the effect of prolonged and repeated exercise on iron metabolism in middle-aged adults and to compare differences between sexes. Methods 50 male (58.9 ± 9.9 year) and 48 female (50.9 ± 11.2 year) individuals were monitored on 4 consecutive days at which they walked on average 8 h and 44 min per day at a self-determined pace. Blood samples were collected 1 or 2 days prior to the start of the exercise (baseline) and every day immediately post-exercise. Samples were analysed for iron, ferritin, haemoglobin, and haptoglobin concentrations. Results Plasma iron decreased across days, while ferritin increased across days (both p < 0.001). Haptoglobin showed a decrease (p < 0.001) after the first day and increased over subsequent days (p < 0.001). Haemoglobin did not change after the first day, but increased during subsequent days (p < 0.05). At baseline, 8% of the participants had iron concentrations below minimum reference value (10 µmol/L), this increased to 43% at day 4. There was an interaction between sex and exercise days on iron (p = 0.028), ferritin (p < 0.001) and haemoglobin levels (p = 0.004), but not on haptoglobin levels. Conclusion This study showed decreases in iron, increases in ferritin, a decrease followed by increases in haptoglobin and no change followed by increases in haemoglobin. This is most likely explained by (foot strike) haemolysis, inflammation, and sweat and urine losses. These processes resulted in iron levels below minimum reference value in a large number of our participants.
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Affiliation(s)
- Rieneke Terink
- Division of Human Nutrition, Wageningen University (WU), Stippeneng 4, building 124, 6708 WE, Wageningen, The Netherlands.
| | - D Ten Haaf
- Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - C W G Bongers
- Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - M G J Balvers
- Division of Human Nutrition, Wageningen University (WU), Stippeneng 4, building 124, 6708 WE, Wageningen, The Netherlands.,Clinical Chemistry and Haematology Laboratory, Gelderse Vallei Hospital (ZGV), Ede, The Netherlands
| | - R F Witkamp
- Division of Human Nutrition, Wageningen University (WU), Stippeneng 4, building 124, 6708 WE, Wageningen, The Netherlands
| | - M Mensink
- Division of Human Nutrition, Wageningen University (WU), Stippeneng 4, building 124, 6708 WE, Wageningen, The Netherlands
| | - T M H Eijsvogels
- Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - J M T Klein Gunnewiek
- Clinical Chemistry and Haematology Laboratory, Gelderse Vallei Hospital (ZGV), Ede, The Netherlands
| | - M T E Hopman
- Division of Human Nutrition, Wageningen University (WU), Stippeneng 4, building 124, 6708 WE, Wageningen, The Netherlands.,Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands
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Lee EC, Fragala MS, Kavouras SA, Queen RM, Pryor JL, Casa DJ. Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. J Strength Cond Res 2018; 31:2920-2937. [PMID: 28737585 PMCID: PMC5640004 DOI: 10.1519/jsc.0000000000002122] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.
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Affiliation(s)
- Elaine C Lee
- 1Department of Kinesiology, University of Connecticut, Storrs, Connecticut; 2Quest Diagnostics, Madison, New Jersey; 3Department of Health, Human Performance, & Recreation, University of Arkansas, Fayetteville, Arkansas; 4Department of Biomedical Engineering and Mechanics, Virginia Tech University, Blacksburg, Virginia; and 5Department of Kinesiology, California State University, Fresno, California
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Abstract
OBJECTIVE To determine the serum hepcidin concentration and standard hematological parameters in a group of female adolescent athletes, compared with a group of nonathlete females. DESIGN A case-control study. SETTING A senior high school for athletes in Gothenburg, Sweden. PARTICIPANTS All female athletes (70), at the school were offered to take part. Fifty-six athletes accepted. From a random sample of age-matched nonathletes, 71 students were recruited to the control group. MAIN OUTCOME MEASURES Iron deficiency (ID) was determined by levels of serum iron, total iron-binding capacity, transferrin saturation (TS), and ferritin. Serum hepcidin was determined by a mass spectrometry method. All samples were taken at least 12 hours after training. RESULTS The main result was the finding of a significantly elevated serum hepcidin level in the athlete group, 4.7 nmol/L compared with 3.3 nmol/L (P < 0.001) in the nonathlete group. In the athlete group, the serum iron concentration was significantly lower, 14.0 μmol/L compared with 17.6 μmol/L (P = 0.003) in the nonathlete group. No difference was found regarding TS, total iron binding capacity, and ferritin. There was no difference in the occurrence of ID or iron deficiency anaemia (IDA). CONCLUSIONS These findings show an increase in serum hepcidin in a large group of female athletes. The elevated hepcidin levels may affect the iron balance of the athletes, adding to the traditional explanation of dietary intake/iron loss balance.
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Effects of an Acute Exercise Bout on Serum Hepcidin Levels. Nutrients 2018; 10:nu10020209. [PMID: 29443922 PMCID: PMC5852785 DOI: 10.3390/nu10020209] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 02/07/2023] Open
Abstract
Iron deficiency is a frequent and multifactorial disorder in the career of athletes, particularly in females. Exercise-induced disturbances in iron homeostasis produce deleterious effects on performance and adaptation to training; thus, the identification of strategies that restore or maintain iron homeostasis in athletes is required. Hepcidin is a liver-derived hormone that degrades the ferroportin transport channel, thus reducing the ability of macrophages to recycle damaged iron, and decreasing iron availability. Although it has been suggested that the circulating fraction of hepcidin increases during early post-exercise recovery (~3 h), it remains unknown how an acute exercise bout may modify the circulating expression of hepcidin. Therefore, the current review aims to determine the post-exercise expression of serum hepcidin in response to a single session of exercise. The review was carried out in the Dialnet, Elsevier, Medline, Pubmed, Scielo and SPORTDiscus databases, using hepcidin (and “exercise” or “sport” or “physical activity”) as a strategy of search. A total of 19 articles were included in the review after the application of the inclusion/exclusion criteria. This search found that a single session of endurance exercise (intervallic or continuous) at moderate or vigorous intensity (60–90% VO2peak) stimulates an increase in the circulating levels of hepcidin between 0 h and 6 h after the end of the exercise bout, peaking at ~3 h post-exercise. The magnitude of the response of hepcidin to exercise seems to be dependent on the pre-exercise status of iron (ferritin) and inflammation (IL-6). Moreover, oxygen disturbances and the activation of a hypoxia-induced factor during or after exercise may stimulate a reduction of hepcidin expression. Meanwhile, cranberry flavonoids supplementation promotes an anti-oxidant effect that may facilitate the post-exercise expression of hepcidin. Further studies are required to explore the effect of resistance exercise on hepcidin expression.
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28
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Sarıkaya B, Dursun AD, Taylan Deveden EY, Pınar L. Interleukin-6 and hepcidin expression changes in cardiac tissue of long-term trained and untrained rats after exhaustive exercise. Turk J Med Sci 2017; 47:1940-1946. [PMID: 29306260 DOI: 10.3906/sag-1703-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Exercise benefits the cardiovascular system, but strenuous exercise can cause cardiac damage and induce cytokine production, particularly that of interleukin-6 (IL-6). Hepcidin, which is primarily regulated by IL-6, increases after exercise. Hepcidin is a possible protective factor against the adverse effects of strenuous exercise such as oxidative stress. The aim of the study is to reveal that training increases hepcidin and attenuates increased levels of IL-6 in the hearts of exhaustively exercised rats by comparing the IL-6 and hepcidin mRNA expression levels in trained and untrained groups.Materials and methods: Thirty male Wistar albino rats were assigned to the following groups: sedentary controls (Con); untrained animals that acutely completed exhaustive exercise and were sacrificed immediately after exhaustion (UT-i) or 1 day after exhaustion (UT-1); and long-term trained animals that completed exhaustive exercise and were sacrificed immediately after exhaustion (T-i) or 1 day after exhaustion (T-1). mRNA levels were examined by reverse transcription PCR. Results: IL-6 levels significantly increased in the UT-i, T-i, and T-1 groups compared to the Con group (P = 0.000, P = 0.024, P = 0.001), with maximal IL-6 expression found in the UT-i group. Hepcidin levels significantly increased in the T-1 group (P = 0.000) compared to the control. Conclusion: Increased IL-6 levels in rats show that exhaustive exercise can cause cardiac inflammation. However, long-term training attenuated the severity of the inflammation. The possible protective effect of increased hepcidin in the trained groups can be explained by the antiinflammatory effects of IL-6 and long-term training.
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Dahlquist DT, Stellingwerff T, Dieter BP, McKenzie DC, Koehle MS. Effects of macro- and micronutrients on exercise-induced hepcidin response in highly trained endurance athletes. Appl Physiol Nutr Metab 2017; 42:1036-1043. [DOI: 10.1139/apnm-2017-0207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Iron deficiency has ergolytic effects on athletic performance. Exercise-induced inflammation impedes iron absorption in the digestive tract by upregulating the expression of the iron regulatory protein, hepcidin. Limited research indicates the potential of specific macro- and micronutrients on blunting exercise-induced hepcidin. Therefore, we investigated the effects of postexercise supplementation with protein and carbohydrate (CHO) and vitamins D3 and K2 on the postexercise hepcidin response. Ten highly trained male cyclists (age: 26.9 ± 6.4 years; maximal oxygen uptake: 67.4 ± 4.4 mL·kg–1·min–1 completed 4 cycling sessions in a randomized, placebo-controlled, single-blinded, triple-crossover study. Experimental days consisted of an 8-min warm-up at 50% power output at maximal oxygen uptake, followed by 8 × 3-min intervals at 85% power output at maximal oxygen uptake with 1.5 min at 60% power output at maximal oxygen uptake between each interval. Blood samples were collected pre- and postexercise, and at 3 h postexercise. Three different drinks consisting of CHO (75 g) and protein (25 g) with (VPRO) or without (PRO) vitamins D3 (5000 IU) and K2 (1000 μg), or a zero-calorie control drink (PLA) were consumed immediately after the postexercise blood sample. Results showed that the postexercise drinks had no significant (p ≥ 0.05) effect on any biomarker measured. There was a significant (p < 0.05) increase in hepcidin and interleukin-6 following intense cycling intervals in the participants. Hepcidin increased significantly (p < 0.05) from baseline (nmol·L–1: 9.94 ± 8.93, 14.18 ± 14.90, 10.44 ± 14.62) to 3 h postexercise (nmol·L–1: 22.27 ± 13.41, 25.44 ± 11.91, 22.57 ± 15.57) in VPRO, PRO, and PLA, respectively. Contrary to our hypothesis, the drink compositions used did not blunt the postexercise hepcidin response in highly trained athletes.
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Affiliation(s)
- Dylan T. Dahlquist
- UBC Environmental Physiology Laboratory, School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- Canadian Sport Institute – Pacific, Victoria, BC V9E 2C5, Canada
| | - Trent Stellingwerff
- UBC Environmental Physiology Laboratory, School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- Canadian Sport Institute – Pacific, Victoria, BC V9E 2C5, Canada
| | - Brad P. Dieter
- Providence Health Care, Providence Sacred Heart Medical Center and Children’s Hospital, Spokane, WA 99204, USA
| | - Donald C. McKenzie
- UBC Environmental Physiology Laboratory, School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- Division of Sports Medicine, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Michael S. Koehle
- UBC Environmental Physiology Laboratory, School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
- Division of Sports Medicine, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
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30
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Goto K, Kasai N, Kojima C, Ishibashi A. Postexercise serum hepcidin response to repeated sprint exercise under normoxic and hypoxic conditions. Appl Physiol Nutr Metab 2017; 43:221-226. [PMID: 28961407 DOI: 10.1139/apnm-2017-0418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We determined the effects of repeated sprint exercise under normoxic and hypoxic conditions on serum hepcidin levels. Ten male athletes (age: 20.9 ± 0.3 years; height: 175.7 ± 6.0 cm; weight: 67.3 ± 6.3 kg) performed 2 exercise trials under normoxic (NOR; fraction of inspiratory oxygen (FiO2): 20.9%) or hypoxic conditions (HYPO; FiO2: 14.5%). The exercise consisted of 3 sets of 5 × 6 s of maximal pedaling (30-s rest periods between sprints, 10-min rest periods between sets). Blood samples were collected before exercise, immediately after exercise, and 1 and 3 h after exercise. Serum hepcidin levels were significantly elevated after exercise in both trials (both P < 0.01), with no significant difference between the trials. The postexercise blood lactate levels were significantly higher in the HYPO than the NOR (P < 0.05). Both trials caused similar increases in plasma interleukin-6 and serum iron levels (P < 0.001), with no significant difference between the trials. A significant interaction (trial × time) was apparent in terms of serum erythropoietin (EPO) levels (P = 0.003). The EPO level was significantly higher in the HYPO than the NOR at 3 h after exercise (P < 0.05). In conclusion, repeated sprint exercise significantly increased serum hepcidin levels to similar extent in 2 trials, despite differences in the inspired oxygen concentrations during both the exercise and the 3-h postexercise period.
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Affiliation(s)
- Kazushige Goto
- a Graduate School of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, 525-8577, Japan
| | - Nobukazu Kasai
- a Graduate School of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, 525-8577, Japan
| | - Chihiro Kojima
- a Graduate School of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, 525-8577, Japan
| | - Aya Ishibashi
- a Graduate School of Sports and Health Science, Ritsumeikan University, Kusatsu, Shiga, 525-8577, Japan.,b Department of Sports Science, Japan Institute of Sports Science, Kitaku, Tokyo, 525-8577, Japan
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31
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Ishibashi A, Maeda N, Kamei A, Goto K. Iron Supplementation during Three Consecutive Days of Endurance Training Augmented Hepcidin Levels. Nutrients 2017; 9:nu9080820. [PMID: 28758951 PMCID: PMC5579614 DOI: 10.3390/nu9080820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 12/21/2022] Open
Abstract
Iron supplementation contributes an effort to improving iron status among athletes, but it does not always prevent iron deficiency. In the present study, we explored the effect of three consecutive days of endurance training (twice daily) on the hepcidin-25 (hepcidin) level. The effect of iron supplementation during this period was also determined. Fourteen male endurance athletes were enrolled and randomly assigned to either an iron-treated condition (Fe condition, n = 7) or a placebo condition (Control condition; CON, n = 7). They engaged in two 75-min sessions of treadmill running at 75% of maximal oxygen uptake on three consecutive days (days 1-3). The Fe condition took 12 mg of iron twice daily (24 mg/day), and the CON condition did not. On day 1, both conditions exhibited significant increases in serum hepcidin and plasma interleukin-6 levels after exercise (p < 0.05). In the CON condition, the hepcidin level did not change significantly throughout the training period. However, in the Fe condition, the serum hepcidin level on day 4 was significantly higher than that of the CON condition (p < 0.05). In conclusion, the hepcidin level was significantly elevated following three consecutive days of endurance training when moderate doses of iron were taken.
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Affiliation(s)
- Aya Ishibashi
- Department of Sports Science, Japan Institute of Sports Science, Nishigaoka, Kitaku, Tokyo 115-0056, Japan.
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Naho Maeda
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Akiko Kamei
- Department of Sports Science, Japan Institute of Sports Science, Nishigaoka, Kitaku, Tokyo 115-0056, Japan.
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
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32
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Peeling P, McKay AKA, Pyne DB, Guelfi KJ, McCormick RH, Laarakkers CM, Swinkels DW, Garvican-Lewis LA, Ross MLR, Sharma AP, Leckey JJ, Burke LM. Factors influencing the post-exercise hepcidin-25 response in elite athletes. Eur J Appl Physiol 2017; 117:1233-1239. [PMID: 28409396 DOI: 10.1007/s00421-017-3611-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/09/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE The extent to which hepcidin regulation after acute bouts of exercise is influenced by baseline (resting) concentrations of key iron parameters remains uncertain. This investigation explored the influence of selected iron parameters and 25-km race walk time on 3-h post-exercise hepcidin-25 levels in international-level race walkers. METHODS Twenty-four male race walkers completed a graded exercise test and a 25-km race-walk trial. Throughout the 25-km race-walk, venous blood samples were collected pre-exercise, immediately post-exercise, and at 3-h post-exercise. Blood was analysed for serum ferritin, serum iron, Interleukin-6 (IL-6), and hepcidin-25 concentration. RESULTS IL-6 and hepcidin-25 increased (7.6- and 7.5-fold, respectively) in response to the 25-km race-walk trial (both p < 0.01). Significant individual relationships were evident between 3-h post-exercise hepcidin-25, baseline serum ferritin and serum iron (r > 0.62; p < 0.05). Multiple regression analysis showed that these two iron parameters, in addition to post-exercise IL-6 concentration and 25-km race-walk time, accounted for ~77% of the variance in 3-h post-exercise hepcidin-25 (p < 0.01). A median split by the cohort's baseline serum ferritin concentration (LOW: 58.0 vs. HIGH: 101.8 µg/L; p < 0.01) showed a significant between group difference in the 3-h post-exercise hepcidin-25 (LOW: 6.0 ± 3.6 vs. 11.3 ± 5.4 nM; p = 0.01), despite no differences in baseline serum iron, post-exercise IL-6, or 25-km race-walk time (all p > 0.05). CONCLUSION Despite exercise activating numerous hepcidin regulators, baseline iron status appears to play a dominant role in the regulation of hepcidin-25 in elite-level athletes subsequent to endurance exercise.
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Affiliation(s)
- Peter Peeling
- Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, WA, 6009, Australia.
- Western Australian Institute of Sport, Mt Claremont, WA, 6010, Australia.
| | - Alannah K A McKay
- Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
- Australian Institute of Sport, Bruce, ACT, 2617, Australia
| | - David B Pyne
- Australian Institute of Sport, Bruce, ACT, 2617, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, 2601, Australia
| | - Kym J Guelfi
- Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Rachel H McCormick
- Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
- Western Australian Institute of Sport, Mt Claremont, WA, 6010, Australia
| | - Coby M Laarakkers
- Department of Laboratory Medicine (LGEM 830), Radboud University Medical Center, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine (LGEM 830), Radboud University Medical Center, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | | | - Megan L R Ross
- Australian Institute of Sport, Bruce, ACT, 2617, Australia
| | - Avish P Sharma
- Australian Institute of Sport, Bruce, ACT, 2617, Australia
| | - Jill J Leckey
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000, Australia
| | - Louise M Burke
- Australian Institute of Sport, Bruce, ACT, 2617, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3000, Australia
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Buyukyazi G, Ulman C, Çelik A, Çetinkaya C, Şişman AR, Çimrin D, Doğru Y, Kaya D. The effect of 8-week different-intensity walking exercises on serum hepcidin, IL-6, and iron metabolism in pre-menopausal women. Physiol Int 2017; 104:52-63. [DOI: 10.1556/2060.104.2017.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective
Hepcidin may be an important mediator in exercise-induced iron deficiency. Despite the studies investigating acute exercise effects on hepcidin and markers of iron metabolism, we found no studies examining the chronic effects of walking exercises (WE) on hepcidin and markers of iron metabolism in premenopausal women. The chronic effects of two 8-week different-intensity WE on hepcidin, interleukin 6 (IL-6), and markers of iron metabolism in pre-menopausal women were examined.
Methods
Exercise groups (EG) [moderate tempo walking group (MTWG), n = 11; brisk walking group (BWG), n = 11] walked 3 days/week, starting from 30 to 51 min. Control group (CG; n = 8) did not perform any exercises. BWG walked at ∼70%–75%; MTWG at ∼50%–55% of HRRmax. VO2max, hepcidin, IL-6, and iron metabolism markers were determined before and after the intervention.
Results
VO2max increased in both EGs, favoring the BWG. Hepcidin increased in the BWG (p < 0.01) and CG (p < 0.05). IL-6 decreased in the BWG and the MTWG (p < 0.05; p < 0.01). While iron, ferritin, transferrin, and transferrin saturation levels did not change in any group, total iron binding capacity (p < 0.05), red blood cells (p < 0.05), and hematocrit (p < 0.01) increased only in the BWG.
Conclusion
Both WE types may be useful to prevent inflammation. However, brisk walking is advisable due to the positive changes in VO2max and some iron metabolism parameters, which may contribute to prevent iron deficiency. The increase in hepcidin levels remains unclear and necessitates further studies.
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Affiliation(s)
- G Buyukyazi
- 1 School of Sport Sciences and Technology, Dokuz Eylül University, Izmir, Turkey
| | - C Ulman
- 2 Department of Biochemistry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - A Çelik
- 1 School of Sport Sciences and Technology, Dokuz Eylül University, Izmir, Turkey
| | - C Çetinkaya
- 1 School of Sport Sciences and Technology, Dokuz Eylül University, Izmir, Turkey
| | - AR Şişman
- 3 Department of Biochemistry, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - D Çimrin
- 3 Department of Biochemistry, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Y Doğru
- 4 Department of Biochemistry, School of Physical Education and Sports, Ege University, Izmir, Turkey
| | - D Kaya
- 5 Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Elevated Serum Hepcidin Levels during an Intensified Training Period in Well-Trained Female Long-Distance Runners. Nutrients 2017; 9:nu9030277. [PMID: 28335426 PMCID: PMC5372940 DOI: 10.3390/nu9030277] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/23/2017] [Accepted: 03/03/2017] [Indexed: 12/18/2022] Open
Abstract
Iron is essential for providing oxygen to working muscles during exercise, and iron deficiency leads to decreased exercise capacity during endurance events. However, the mechanism of iron deficiency among endurance athletes remains unclear. In this study, we compared iron status between two periods involving different training regimens. Sixteen female long-distance runners participated. Over a seven-month period, fasting blood samples were collected during their regular training period (LOW; middle of February) and during an intensified training period (INT; late of August) to determine blood hematological, iron, and inflammatory parameters. Three-day food diaries were also assessed. Body weight and lean body mass did not differ significantly between LOW and INT, while body fat and body fat percentage were significantly lower in INT (p < 0.05). Blood hemoglobin, serum ferritin, total protein, and iron levels, total iron-binding capacity, and transferrin saturation did not differ significantly between the two periods. Serum hepcidin levels were significantly higher during INT than LOW (p < 0.05). Carbohydrate and iron intakes from the daily diet were significantly higher during INT than LOW (p < 0.05). In conclusion, an elevated hepcidin level was observed during an intensified training period in long-distance runners, despite an apparently adequate daily intake of iron.
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Relationship between the Ingestion of a Polyphenol-Rich Drink, Hepcidin Hormone, and Long-Term Training. Molecules 2016; 21:molecules21101333. [PMID: 27740603 PMCID: PMC6273972 DOI: 10.3390/molecules21101333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 12/21/2022] Open
Abstract
The effects of polyphenol-rich foods on the iron status of athletes, as well as the effect of physical training on the hormone hepcidin, implicated in iron metabolism, are not clear. We investigated the influence on iron metabolism of a long-term training intervention of 120 days, measuring the hepcidin concentration in the plasma of 16 elite triathletes, and the effect of the ingestion of 200 mL of either aronia-citrus juice or a placebo drink for 45 days, in a crossover design. The highest plasma hepcidin concentrations were observed at the beginning of the study (116 ± 63 nM) and levels steadily decreased until the end of the intervention (final value 10 ± 7.5 nM). Long-term training might reduce inflammation and, hence, could be responsible for the decrease in hepcidin in triathletes. Polyphenols from aronia-citrus juice did not interfere in iron absorption, as we did not observe significant differences between the intake of the placebo drink or juice with regard to hepcidin levels. Further studies are required to ascertain the time and conditions necessary to restore hepcidin levels, which reflect the iron status of triathletes.
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Pasiakos SM, Margolis LM, Murphy NE, McClung HL, Martini S, Gundersen Y, Castellani JW, Karl JP, Teien HK, Madslien EH, Stenberg PH, Young AJ, Montain SJ, McClung JP. Effects of exercise mode, energy, and macronutrient interventions on inflammation during military training. Physiol Rep 2016; 4:4/11/e12820. [PMID: 27273884 PMCID: PMC4908496 DOI: 10.14814/phy2.12820] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 01/28/2023] Open
Abstract
Load carriage (LC) exercise may exacerbate inflammation during training. Nutritional supplementation may mitigate this response by sparing endogenous carbohydrate stores, enhancing glycogen repletion, and attenuating negative energy balance. Two studies were conducted to assess inflammatory responses to acute LC and training, with or without nutritional supplementation. Study 1: 40 adults fed eucaloric diets performed 90-min of either LC (treadmill, mean ± SD 24 ± 3 kg LC) or cycle ergometry (CE) matched for intensity (2.2 ± 0.1 VO2peak L min(-1)) during which combined 10 g protein/46 g carbohydrate (223 kcal) or non-nutritive (22 kcal) control drinks were consumed. Study 2: 73 Soldiers received either combat rations alone or supplemented with 1000 kcal day(-1) from 20 g protein- or 48 g carbohydrate-based bars during a 4-day, 51 km ski march (~45 kg LC, energy expenditure 6155 ± 515 kcal day(-1) and intake 2866 ± 616 kcal day(-1)). IL-6, hepcidin, and ferritin were measured at baseline, 3-h post exercise (PE), 24-h PE, 48-h PE, and 72-h PE in study 1, and before (PRE) and after (POST) the 4-d ski march in study 2. Study 1: IL-6 was higher 3-h and 24-h post exercise (PE) for CE only (mode × time, P < 0.05), hepcidin increased 3-h PE and recovered by 48-h, and ferritin peaked 24-h and remained elevated 72-h PE (P < 0.05), regardless of mode and diet. Study 2: IL-6, hepcidin and ferritin were higher (P < 0.05) after training, regardless of group assignment. Energy expenditure (r = 0.40), intake (r = -0.26), and balance (r = -0.43) were associated (P < 0.05) with hepcidin after training. Inflammation after acute LC and CE was similar and not affected by supplemental nutrition during energy balance. The magnitude of hepcidin response was inversely related to energy balance suggesting that eating enough to balance energy expenditure might attenuate the inflammatory response to military training.
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Affiliation(s)
- Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Holy L McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Svein Martini
- Norwegian Defence Research Establishment, Kjeller, Norway
| | | | - John W Castellani
- Thermal Mountain and Medicine Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - James P Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Hilde K Teien
- Norwegian Defence Research Establishment, Kjeller, Norway
| | | | - Pal H Stenberg
- General Defence Material/Catering and Combat Feeding Section, Norwegian Navy, Rødskiferveien, Norway
| | - Andrew J Young
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Scott J Montain
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Dzhelebov P, Gundasheva D, Andonova M, Tsoneva V, Marutsov P, Slavov E. Influence of exhaustive aerobic exercise on some cytokines and serum iron parameters in canine experimental model. COMPARATIVE EXERCISE PHYSIOLOGY 2016. [DOI: 10.3920/cep160003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of the experiment was to study the effect of exhaustive exercise on some cytokines and iron status parameters. We used 12 male, mongrel dogs divided into two groups – animals from experimental group were submitted to exercise at moderate intensity with exhaustion as the end-point; animals from control group did no exercise. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), hepcidin prohormone, serum iron (SI), total iron binding capacity (TIBC) and transferrin saturation (TS) were measured before exercise (BE), right after exercise (0 hour) and on 2, 4, 24, 48 and 72 hours after exercise. SI, TIBC and TS were measured also on day 7 and 14 after exercise. Serum levels of TNF-α increased after the exhaustive exercise. Serum levels of IL-6 demonstrated an increase at 0 hour, but increase was not statistically significant compared to BE level. Serum levels of hepcidin prohormone marked a slight increase 48 hours after the exercise, but change was insignificant. Levels of SI decreased on hour 72 (P<0.01) and on day 7 (P<0.01) and 14 (P<0.05) after the exercise, as compared to BE level. Similar were changes in TS. TIBC decreased on 4, 24 and 72 hours (P<0.05) after exercise, but only compared to control group. In conclusion, exhaustive exercise causes inflammatory response and a significant decrease in SI levels.
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Affiliation(s)
- P. Dzhelebov
- Department of General and Clinical Pathology, Faculty of Veterinary Medicine, Trakia University, Student Campus, Block 7, 6015 Stara Zagora, Bulgaria
| | - D. Gundasheva
- Department of General and Clinical Pathology, Faculty of Veterinary Medicine, Trakia University, Student Campus, Block 7, 6015 Stara Zagora, Bulgaria
| | - M. Andonova
- Department of General and Clinical Pathology, Faculty of Veterinary Medicine, Trakia University, Student Campus, Block 7, 6015 Stara Zagora, Bulgaria
| | - V. Tsoneva
- Department of Central Clinical Laboratory, Faculty of Medicine, Trakia University, Armeiska Str. 11, 6000 Stara Zagora, Bulgaria
| | - P. Marutsov
- Department of General and Clinical Pathology, Faculty of Veterinary Medicine, Trakia University, Student Campus, Block 7, 6015 Stara Zagora, Bulgaria
| | - E. Slavov
- Department of General and Clinical Pathology, Faculty of Veterinary Medicine, Trakia University, Student Campus, Block 7, 6015 Stara Zagora, Bulgaria
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Dzedzej A, Ignatiuk W, Jaworska J, Grzywacz T, Lipińska P, Antosiewicz J, Korek A, Ziemann E. The effect of the competitive season in professional basketball on inflammation and iron metabolism. Biol Sport 2016; 33:223-9. [PMID: 27601776 PMCID: PMC4993137 DOI: 10.5604/20831862.1201811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/20/2015] [Accepted: 01/14/2016] [Indexed: 12/21/2022] Open
Abstract
Following acute physical activity, blood hepcidin concentration appears to increase in response to exercise-induced inflammation, but the long-term impact of exercise on hepcidin remains unclear. Here we investigated changes in hepcidin and the inflammation marker interleukin-6 to evaluate professional basketball players' response to a season of training and games. The analysis also included vitamin D (25(OH)D3) assessment, owing to its anti-inflammatory effects. Blood samples were collected for 14 players and 10 control non-athletes prior to and after the 8-month competitive season. Athletes' performance was assessed with the NBA efficiency score. At the baseline hepcidin correlated with blood ferritin (r = 0.61; 90% CL ±0.31), but at the end of the season this correlation was absent. Compared with the control subjects, athletes experienced clear large increases in hepcidin (50%; 90% CI 15-96%) and interleukin-6 (77%; 90% CI 35-131%) and a clear small decrease in vitamin D (-12%; 90% CI -20 to -3%) at the season completion. Correlations between change scores of these variables were unclear (r = -0.21 to 0.24, 90% CL ±0.5), but their uncertainty generally excluded strong relationships. Athletes were hence concluded to have experienced acute inflammation at the beginning but chronic inflammation at the end of the competitive season. At the same time, the moderate correlation between changes in vitamin D and players' performance (r = 0.43) was suggestive of its beneficial influence. Maintaining the appropriative concentration of vitamin D is thus necessary for basketball players' performance and efficiency. The assessment of hepcidin has proven to be useful in diagnosing inflammation in response to chronic exercise.
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Affiliation(s)
- A Dzedzej
- Gdansk University of Physical Education and Sport, Department of Physiology and Pharmacology, Gdansk, Poland
| | - W Ignatiuk
- Gdansk University of Physical Education and Sport, Department of Physiology and Pharmacology, Gdansk, Poland
| | - J Jaworska
- Gdansk University of Physical Education and Sport, Department of Physiology and Pharmacology, Gdansk, Poland
| | - T Grzywacz
- Institute of Sport - National Research Institute, Department of Physiology, Warsaw, Poland
| | - P Lipińska
- Institute of Sport - National Research Institute, Department of Biomechanics, Warsaw, Poland
| | - J Antosiewicz
- Medical University of Gdansk, Department of Bioenergetics and Physiology of Exercise, Gdansk, Poland
| | - A Korek
- Basketball Team, Asseco Prokom, Gdynia, Poland
| | - E Ziemann
- Gdansk University of Physical Education and Sport, Department of Physiology and Pharmacology, Gdansk, Poland
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Buratti P, Gammella E, Rybinska I, Cairo G, Recalcati S. Recent Advances in Iron Metabolism: Relevance for Health, Exercise, and Performance. Med Sci Sports Exerc 2016; 47:1596-604. [PMID: 25494391 DOI: 10.1249/mss.0000000000000593] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Iron is necessary for physiological processes essential for athletic performance, such as oxygen transport, energy production, and cell division. However, an excess of "free" iron is toxic because it produces reactive hydroxyl radicals that damage biological molecules, thus leading to cell and tissue injury. Therefore, iron homeostasis is strictly regulated; and in recent years, there have been important advancements in our knowledge of the underlying processes. Hepcidin is the central regulator of systemic iron homeostasis and exerts its function by controlling the presence of the iron exporter ferroportin on the cell membrane. Hepcidin binding induces ferroportin degradation, thus leading to cellular iron retention and decreased levels of circulating iron. As iron is required for hemoglobin synthesis, the tight link between erythropoiesis and iron metabolism is particularly relevant to sports physiology. The iron needed for hemoglobin synthesis is ensured by inhibiting hepcidin to increase ferroportin activity and iron availability and hence to make certain that efficient blood oxygen transport occurs for aerobic exercise. However, hepcidin expression is also affected by exercise-associated conditions, such as iron deficiency, anemia or hypoxia, and, particularly, inflammation, which can play a role in the pathogenesis of sports anemia. Here, we review recent advances showing the relevance of iron for physical exercise and athletic performance. Low body iron levels can cause anemia and thus limit the delivery of oxygen to exercising muscle, but tissue iron deficiency may also affect performance by, for example, hampering muscle oxidative metabolism. Accordingly, a hemoglobin-independent effect of iron on exercise capacity has been demonstrated in animal models and humans. Here, we review recent advances showing the relevance of iron for physical exercise and athletic performance.
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Affiliation(s)
- Paolo Buratti
- Department of Biomedical Sciences for Health, University of Milan, Milan, ITALY
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Badenhorst CE, Dawson B, Cox GR, Laarakkers CM, Swinkels DW, Peeling P. Timing of post-exercise carbohydrate ingestion: influence on IL-6 and hepcidin responses. Eur J Appl Physiol 2015; 115:2215-22. [PMID: 26084589 DOI: 10.1007/s00421-015-3202-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Carbohydrate ingestion prior and during exercise attenuates exercise-induced interleukin-6. This investigation examined if an analogous effect was evident for interleukin-6 and hepcidin response when carbohydrates were ingested post-exercise. METHODS In a crossover design, 11 well-trained endurance athletes completed two experimental trials. Participants completed an 8 × 3 min interval running session at 85 % vVO2peak followed by 5 h of monitored recovery. During this period, participants were provided with two 1.2 g kg(-1) carbohydrate beverages at either an early feeding time (immediately post-exercise and 2 h post-exercise) or delayed feeding time (2 h post-exercise and 4 h post-exercise). Venous blood samples were collected pre-, immediately post-, 3 and 5 h post-exercise. Samples were analysed for Interleukin-6, serum iron, serum ferritin and hepcidin. RESULTS Interleukin-6 was significantly elevated (p = 0.004) immediately post-exercise compared to baseline for both trials. Hepcidin levels were significantly elevated at 3 h post-exercise (p = 0.001) and 5 h post-exercise (p = 0.002) compared to baseline levels in both trials, with no significant difference between the two conditions and any time point. Serum iron was significantly increased from baseline to immediately post-exercise (p = 0.001) for both trials, with levels decreasing by 3 h (p = 0.025) and 5 h post-exercise (p = 0.001). Serum ferritin levels increased immediately post-exercise compared to baseline (p = 0.006) in both conditions. CONCLUSIONS The timing and ingestion of post-exercise carbohydrate ingestion do not appear to impact post-exercise interleukin-6 and hepcidin responses; this is likely a result of the interval running task inducing an inflammatory response and subsequent up-regulation of hepcidin.
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Affiliation(s)
- Claire E Badenhorst
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Brian Dawson
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Gregory R Cox
- Sports Nutrition, Australian Institute of Sport, Gold Coast, Queensland, Australia
| | - Coby M Laarakkers
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, The Netherlands.,Hepcidinanalysis.com, Geert Grooteplein 10 (830), 6525 GA, Nijmegen, The Netherlands
| | - Peter Peeling
- School of Sport Science, Exercise and Health (M408), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
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Deldicque L, Francaux M. Recommendations for Healthy Nutrition in Female Endurance Runners: An Update. Front Nutr 2015; 2:17. [PMID: 26075206 PMCID: PMC4443719 DOI: 10.3389/fnut.2015.00017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 01/01/2023] Open
Abstract
The purpose of this review is to present the basic principles of a healthy nutrition in female endurance runner enriched by the latest scientific recommendations. Female endurance runners are a specific population of athletes who need to take specifically care of daily nutrition due to the high load of training and the necessity to keep a rather low body mass. This paradoxical situation can create some nutritional imbalances and deficiencies. Female endurance athletes should pay attention to their total energy intake, which is often lower than their energy requirement. The minimal energy requirement has been set to 45 kcal/kg fat free mass/day plus the amount of energy needed for physical activity. The usual recommended amount of 1.2–1.4 g protein/kg/day has recently been questioned by new findings suggesting that 1.6 g/kg/day would be more appropriate for female athletes. Although a bit less sensitive to carbohydrate loading than their male counterparts, female athletes can benefit from this nutritional strategy before a race if the amount of carbohydrates reaches 8 g/kg/day and if their daily total energy intake is sufficient. A poor iron status is a common issue in female endurance runners but iron-enriched food as well as iron supplementation may help to counterbalance this poor status. Finally, they should also be aware that they may be at risk for low calcium and vitamin D levels.
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Affiliation(s)
- Louise Deldicque
- Exercise Physiology Research Group, Department of Kinesiology, Faber, KU Leuven , Leuven , Belgium
| | - Marc Francaux
- Institute of Neuroscience, Université catholique de Louvain , Louvain-la-Neuve , Belgium
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Mielgo-Ayuso J, Zourdos MC, Calleja-González J, Urdampilleta A, Ostojic S. Iron supplementation prevents a decline in iron stores and enhances strength performance in elite female volleyball players during the competitive season. Appl Physiol Nutr Metab 2015; 40:615-22. [PMID: 25965846 DOI: 10.1139/apnm-2014-0500] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The primary aim of this study was to examine the effects of 11 weeks of iron supplementation on hematological and strength markers in elite female volleyball players. Twenty-two volleyball players (aged 27.0 ± 5.6 years) from 2 Spanish First National League teams participated and were counterbalanced into 1 of 2 groups based upon iron status: (i) control group (CG, n = 11); or (ii) iron treatment group (ITG, n = 11), which received 325 mg/day of ferrous sulphate daily. Subjects performed their team's regimen of training or match play every day. Both groups were tested for hematological and strength levels at 2 points: (i) baseline (T0, before preseason) and (ii) 11 weeks later (T11, post-testing). Hematological parameters were serum iron (sFe), serum ferritin (FER), transferrin saturation index (TSI), and hemoglobin (Hb); strength assessments were bench press, military press, half-squat, power clean, clean and jerk, and pull-over. CG experienced a significant decrease (p < 0.05) for sFe (T0, 112.7 ± 31.5; T11, 69.0 ± 20.5 μg·dL(-1); -33.9%), FER (T0, 60.2 ± 28.6; T11, 38.2 ± 16.4 ng·mL(-1); -34.6%), TSI (T0, 29.4% ± 9.5%; T11, 17.4% ± 5.1%; -35.3%), and Hb (T0, 14.1 ± 1.0; T11, 13.0 ± 0.8 g·L(-1); -7.44%); however, ITG experienced no changes (p > 0.05). Consequently, in ITG all hematological parameters were significantly greater (p < 0.05) than CG at T11. There was greater (p < 0.05) percent increase in the clean and jerk (CG: +5.1% ± 20.9 vs. ITG: +29.0% ± 21.3%), power clean (CG: -5.8% ± 30.3% vs. ITG: +44.6% ± 56.6%), and total mean strength (CG: +10.9% ± 3.2% vs. ITG: +26.2% ± 3.6%) in ITG. Our findings suggest that oral iron supplementation prevents iron loss and enhances strength in female volleyball players during the competitive season.
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Affiliation(s)
- Juan Mielgo-Ayuso
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Technical University of Madrid, 28040 Madrid, Spain., Department of Nutrition and Dietetics, Haro Volleyball Club, Nutrition Centre of La Rioja, 26200 Haro, La Rioja, Spain
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44
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Effects of physical activity upon the liver. Eur J Appl Physiol 2014; 115:1-46. [DOI: 10.1007/s00421-014-3031-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/14/2014] [Indexed: 02/07/2023]
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Fujii T, Matsuo T, Okamura K. Effects of resistance exercise on iron absorption and balance in iron-deficient rats. Biol Trace Elem Res 2014; 161:101-6. [PMID: 25055926 DOI: 10.1007/s12011-014-0075-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
We have previously reported that resistance exercise improved the iron status in iron-deficient rats. The current study investigated the mechanisms underlying this exercise-related effect. Male 4-week-old rats were divided into a group sacrificed at the start (week 0) (n = 7), a group maintained sedentary for 6 weeks (S) or a group that performed exercise for 6 weeks (E), and all rats in the latter groups were fed an iron-deficient diet (12 mg iron/kg) for 6 weeks. The rats in the E group performed climbing exercise (5 min × 6 sets/day, 3 days/week). Compared to the week 0 rats, the rats in the S and E groups showed lower tissue iron content, and the hematocrit, hemoglobin, plasma iron, and transferrin saturation values were all low. However, the tissue iron content and blood iron status parameters, and the whole body iron content measured using the whole body homogenates of the rats, did not differ between the S group and the E group. The messenger RNA (mRNA) expression levels of hepcidin, duodenal cytochrome b, divalent metal transporter 1, and ferroportin 1 did not differ between the S group and the E group. The apparent absorption of iron was significantly lower in the E group than in the S group. Therefore, it was concluded that resistance exercise decreases iron absorption, whereas the whole body iron content is not affected, and an increase in iron recycling in the body seems to be responsible for this effect.
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Affiliation(s)
- Takako Fujii
- Exercise Nutrition Laboratory, Graduate School of Sport Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan,
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McClung JP, Gaffney-Stomberg E, Lee JJ. Female athletes: a population at risk of vitamin and mineral deficiencies affecting health and performance. J Trace Elem Med Biol 2014; 28:388-92. [PMID: 25060302 DOI: 10.1016/j.jtemb.2014.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adequate vitamin and mineral status is essential for optimal human health and performance. Female athletes could be at risk for vitamin and mineral insufficiency due to inadequate dietary intake, menstruation, and inflammatory responses to heavy physical activity. Recent studies have documented poor iron status and associated declines in both cognitive and physical performance in female athletes. Similarly, insufficient vitamin D and calcium status have been observed in female athletes, and may be associated with injuries, such as stress fracture, which may limit a female athlete's ability to participate in regular physical activity. This review will focus on recent studies detailing the prevalence of poor vitamin and mineral status in female athletes, using iron, vitamin D, and calcium as examples. Factors affecting the dietary requirement for these vitamins and minerals during physical training will be reviewed. Lastly, countermeasures for the prevention of inadequate vitamin and mineral status will be described.
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Affiliation(s)
- James P McClung
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States.
| | - Erin Gaffney-Stomberg
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States
| | - Jane J Lee
- Department of Nutritional Science, University of Texas at Austin, Austin, TX 78712, United States
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Abstract
Iron is a trace mineral that is highly significant to endurance athletes. Iron is critical to optimal athletic performance because of its role in energy metabolism, oxygen transport, and acid-base balance. Endurance athletes are at increased risk for suboptimal iron status, with potential negative consequences on performance, because of the combination of increased iron needs and inadequate dietary intake. This review paper summarizes the role of iron in maximal and submaximal exercise and describes the effects of iron deficiency on exercise performance. Mechanisms that explain the increased risk of iron deficiency in endurance athletes, including exercise-associated inflammation and hepcidin release on iron sequestration, are described. Information on screening athletes for iron deficiency is presented, and suggestions to increase iron intake through diet modification or supplemental iron are provided.
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Affiliation(s)
- Pamela S Hinton
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
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Abstract
Iron is an important mineral element used by the body in a variety of metabolic and physiologic processes. These processes are highly active when the body is undergoing physical exercises. Prevalence of exercise-induced iron deficiency anemia (also known as sports anemia) is notably high in athletic populations, particularly those with heavy training loads. The pathogenesis of sports anemia is closely related to disorders of iron metabolism, and a more comprehensive understanding of the mechanism of iron metabolism in the course of physical exercises could expand ways of treatment and prevention of sports anemia. In recent years, there have been remarkable research advances regarding the molecular mechanisms underlying changes of iron metabolism in response to physical exercises. This review has covered these advances, including effects of exercise on duodenum iron absorption, serum iron status, iron distribution in organs, erythropoiesis, and hepcidin’s function and its regulation. New methods for the treatment of exercise-induced iron deficiency are also discussed.
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Affiliation(s)
- Wei-Na Kong
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China ; Bioreactor and Protein Drug Research and Development Center of Hebei Universities, Hebei Chemical & Pharmaceutical College, Shijiazhuang 050026, Hebei Province, P. R. China
| | - Guofen Gao
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China
| | - Yan-Zhong Chang
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China
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49
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Peeling P, Sim M, Badenhorst CE, Dawson B, Govus AD, Abbiss CR, Swinkels DW, Trinder D. Iron status and the acute post-exercise hepcidin response in athletes. PLoS One 2014; 9:e93002. [PMID: 24667393 PMCID: PMC3965532 DOI: 10.1371/journal.pone.0093002] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/27/2014] [Indexed: 12/21/2022] Open
Abstract
This study explored the relationship between serum ferritin and hepcidin in athletes. Baseline serum ferritin levels of 54 athletes from the control trial of five investigations conducted in our laboratory were considered; athletes were grouped according to values <30 μg/L (SF<30), 30-50 μg/L (SF30-50), 50-100 μg/L (SF50-100), or >100 μg/L (SF>100). Data pooling resulted in each athlete completing one of five running sessions: (1) 8 × 3 min at 85% vVO2peak; (2) 5 × 4 min at 90% vVO2peak; (3) 90 min continuous at 75% vVO2peak; (4) 40 min continuous at 75% vVO2peak; (5) 40 min continuous at 65% vVO2peak. Athletes from each running session were represented amongst all four groups; hence, the mean exercise duration and intensity were not different (p>0.05). Venous blood samples were collected pre-, post- and 3 h post-exercise, and were analysed for serum ferritin, iron, interleukin-6 (IL-6) and hepcidin-25. Baseline and post-exercise serum ferritin levels were different between groups (p<0.05). There were no group differences for pre- or post-exercise serum iron or IL-6 (p>0.05). Post-exercise IL-6 was significantly elevated compared to baseline within each group (p<0.05). Pre- and 3 h post-exercise hepcidin-25 was sequentially greater as the groups baseline serum ferritin levels increased (p<0.05). However, post-exercise hepcidin levels were only significantly elevated in three groups (SF30-50, SF50-100, and SF>100; p<0.05). An athlete's iron stores may dictate the baseline hepcidin levels and the magnitude of post-exercise hepcidin response. Low iron stores suppressed post-exercise hepcidin, seemingly overriding any inflammatory-driven increases.
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Affiliation(s)
- Peter Peeling
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Marc Sim
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Claire E. Badenhorst
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Brian Dawson
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Andrew D. Govus
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Western Australia, Australia
| | - Chris R. Abbiss
- Centre for Exercise and Sports Science Research, School of Exercise and Health Science, Edith Cowan University, Western Australia, Australia
| | - Dorine W. Swinkels
- Department of Laboratory Medicine, Laboratory of Genetic, Endocrine and Metabolic diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
- Hepcidinanalysis.com, Nijmegen, The Netherlands
| | - Debbie Trinder
- School of Medicine and Pharmacology, The University of Western Australia, Fremantle, Western Australia, Australia
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Sanchis-Gomar F, Lippi G. Physical activity - an important preanalytical variable. Biochem Med (Zagreb) 2014; 24:68-79. [PMID: 24627716 PMCID: PMC3936967 DOI: 10.11613/bm.2014.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/11/2013] [Indexed: 01/13/2023] Open
Abstract
The concentration of several biochemical and hematological biomarkers is strongly influenced by a number of preanalytical variables. Several lines of evidence attest that short, middle, and long-term exercise, as well as the relative intensity of physical effort (from mild to strenuous), may influence a broad array of laboratory variables. The amount of extracellular release and clearance from blood of most of these biomarkers is markedly influenced by the biological characteristics of the molecule(s), level of training, type, intensity and duration of exercise, and time of recovery after training. It is hence noteworthy that test results that fall outside the conventional reference ranges in athletes not only may reflect the presence of a given disease, but may frequently mirror an adaptation to regular training or changes that have occurred during and/or following strenuous exercise, and which should be clearly acknowledged to prevent misinterpretation of laboratory data. The aim of this narrative review is to provide an update about the most significant changes of some biochemical and hematological biomarkers in response to physical exercise, for appropriate interpretation of these changes in the context of physically active subjects.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia; Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
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